Correlation between endometriosis and pelvic pain

Porpora MG; Koninckx PR; Piazze J; Natili M; Colagrande S; Cosmi EV

doi:10.1016/s1074-3804(99)80006-1

General Gynecology Pelvic Pain

Correlation between endometriosis and pelvic pain

Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV

Published November 5, 1999 The Journal of the American Association of Gynecologic Laparoscopists, 6(4), 429-434

DOI 10.1016/s1074-3804(99)80006-1 PMID 10548700

RRM Academy Synopsis

Deep endometriosis and pelvic adhesions predict endometriosis pain

Deep endometriosis and pelvic adhesions predicted pain in 90 women with endometriosis. This was a prospective observational study at a university hospital. The women rated their pain before surgery. Stage on the standard scoring system showed no link to pain severity.

Study at a glance, prospective observational study: Deep endometriosis and pelvic adhesions predicted pain in endometriosis — Study at a glance, prospective observational study of 90 women: Deep endometriosis and pelvic adhesions predicted pain in endometriosis. Source: Porpora MG et al., 1999, PMID 10548700.

Key Findings

Ten of the 90 women had no pain. Dysmenorrhea affected 72 women, chronic pelvic pain (CPP) 55, and deep dyspareunia (pain during deep intercourse) 39.
Deep endometriosis on the uterosacral ligaments correlated with CPP severity (p = 0.0001), deep dyspareunia severity (p = 0.04), and total pain score (p = 0.0001).
Pelvic adhesions correlated with dysmenorrhea severity (p = 0.004) and CPP severity (p = 0.02). Peritoneal adhesions correlated with total pain score (p = 0.01).
No significant correlation was found between pain scores and revised American Fertility Society stage, ovarian endometrioma presence and size, or extent, type, and site of peritoneal lesions.
By logistic regression, CPP was predicted by deep endometriosis (p = 0.0001) and by ovarian endometriomas with adnexal adhesions (p = 0.03).

Interpretation

The authors conclude the data strongly suggest adhesions cause pain in women with ovarian endometriomas. The authors note that pain rates are probably an overestimate, since 69 of the 90 women had surgery specifically for pain. The findings support larger studies of deep endometriosis and pelvic adhesions as drivers of pelvic pain.

RRM Context

Restorative reproductive medicine looks for the cause of each woman's pain. A stage label leaves that question open. In this study, deep lesions and adhesions around the ovary tracked with pain. The surgeons removed adhesions, removed ovarian endometriomas completely, and excised lesions on the uterosacral ligaments.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To evaluate the relationship between prevalence and severity of chronic pelvic pain (CPP) and stage, site, and type of endometriosis.

Design

Prospective, observational study (Canadian Task Force classification II-2).

Setting

University Hospital.

Patients

Of 90 consecutive women with biopsy-proved endometriosis, laparoscopy was performed in 69 for pelvic pain and in 21 for infertility or clinical and ultrasonographic suspicion of ovarian endometriosis.

Intervention

Preoperatively, using a 10-point visual analog scale, the severity of dysmenorrhea, CPP, and deep dyspareunia was assessed. During laparoscopy all visible endometriotic lesions were recorded and treated.

Measurements and Main Results

Ten women (11.1%) had no pain; 72 had dysmenorrhea (mild in 13, moderate in 37, severe in 22); 55 had CPP (mild in 11, moderate in 25, severe in 19); and 39 deep dyspareunia (mild in 5, moderate in 31, severe in 3). The severity of dysmenorrhea significantly correlated with the presence and extent of pelvic adhesions (p = 0.004); the severity of CPP correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001) and extent of pelvic adhesions (p = 0.02); and deep dyspareunia correlated with deep endometriosis on the uterosacral ligaments (p = 0.04). Total pain score significantly correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001), peritoneal adhesions (p = 0.01), and extent of adnexal adhesions (p = 0.01). No significant correlation was found among revised American Fertility Society stage of endometriosis; presence and size of ovarian endometriomas; extent, type, and site of peritoneal lesions; and pain scores. By logistic regression analysis, the presence and intensity of total pain could be predicted simultaneously by the presence of deep endometriosis (p = 0.0001) and presence and extent of adnexal adhesions without cystic endometriosis (p = 0.01), and by the presence of ovarian endometrioma with periovarian adhesions (p = 0.03). Chronic pelvic pain was predicted by both deep endometriosis (p = 0.0001) and ovarian endometriomas with adnexal adhesions (p = 0.03). Deep dyspareunia was predicted simultaneously by deep endometriosis (p = 0.01) and an ovarian endometrioma with periovarian adhesions (p = 0. 008).

Conclusion

Deep endometriosis, pelvic adhesions, and ovarian cystic endometriosis were independent predictors of pelvic pain. These data strongly suggest that it is not the size of ovarian cystic endometriosis but the association with adhesions that causes pelvic pain.

Topics

General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Sexual Health › Sexual Pain › Dyspareunia

Maria Grazia Porpora

M Porpora

PMID 10548700 10548700 DOI 10.1016/s1074-3804(99)80006-1 10.1016/s1074-3804(99)80006-1 Porpora et al. 1999, Porpora 1999

Keywords

Adolescent, Adult, Chronic Disease, Dysmenorrhea/diagnosis/etiology, Dyspareunia/diagnosis/etiology, Endometriosis/complications/diagnosis/surgery, Female, Humans, Laparoscopy, Middle Aged, Ovarian Diseases/complications/diagnosis, Pain Measurement, Pelvic Pain/etiology, Prospective Studies, Tissue Adhesions/complications

Correlation between endometriosis and pelvic pain

Deep endometriosis and pelvic adhesions predict endometriosis pain

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords